Non-Accidental Trauma & Child AbuseClinical Guidelines Knowledge Check
Non-accidental trauma (NAT) is a leading cause of childhood traumatic injury and death in the United States. In the most recent data published by the National Child Abuse and Neglect Data System, there were 1,585 fatalities due to child abuse and neglect in 2015. Approximately 44% percent of those suffered death due to physical abuse and almost 75% were children <3 years old.
No care provider wants to miss non-accidental trauma and potentially expose a child to additional harm. However, mistakenly characterizing an injury as child abuse can have serious consequences for families. What follows is a guide to red flags, patterns of injury that may signal abuse, and differential diagnoses that may also account for trauma.
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Today’s Guideline Knowledge Check question comes from the desk of Med-Challenger Emergency Medicine Editor-in-Chief, Andrea Eberly, MD, FAAEM.
Non-accidental trauma or suspected child abuse cases have their own unique challenges. The first trick is recognition.
The National Child Welfare Guidelines summarize reporting requirements for child abuse. However, the true challenge is diagnosing non-accidental trauma or abuse in the first place. Many times the aspects of potential abuse aren't recognized during the treatment of the presenting trauma itself. Plus, a mistaken diagnosis of abuse can carry it's own consequences. So, what are current challenges and advances regarding identifying non-accidental trauma and pediatric abuse?
Try this review question and find out if you’re following the most current guideline regarding non-accidental trauma and child abuse.
A 2-year-old girl presents apneic and in asystole to the emergency department, accompanied by distraught parents who state that they found her lifeless in the morning.
They deny trauma and state that she was previously healthy. The body is still warm and without lividity.
Her abdomen is distended and shows faint central and lateral bruising (Cullen’s and Grey Turner’s signs).
A chart review shows that she presented 3 days ago for fussiness and vomiting, and that she was discharged with a diagnosis of acute gastroenteritis.
A quick post-mortem survey shows a forearm fracture; a post-mortem skeletal survey shows rib fractures and a preliminary diagnosis of non-accidental trauma (NAT) is made.
Which of the following statements is correct with regards to abuse patterns, diagnosis, and reporting obligations?
Up to 10% of pediatric patients who present with major NAT have a history of recently presenting to the health care system during a sentinel abuse event was missed.
An intensive program consisting of guideline standardization, staff education, and electronic algorithms may improve adherence to age-specific guidelines for evaluating NAT from under 50% to nearly 70%.
Abdominal trauma is the leading cause of death from NAT due to the disproportionally greater challenge of diagnosing abdominal trauma due to NAT during an early presentation.
Corporal punishment laws are inconsistent from State to State, with corporal punishment being permissible in 60% of States; however, corporal punishment with an object is illegal in all USA States.
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About Guideline Knowledge Checks:
With each update of national clinical practice guidelines, some recommendations change and many remain unchanged. Med-Challenger Guideline Knowledge Checks help you know both what is new and what has stayed the same in the most recent guidelines pertinent to each medical specialty.
About the Author:
Andrea Eberly, MD, FAAEM graduated from the David Geffen Medical School of Los Angeles (UCLA) and completed her residency in Emergency Medicine at the University Medical Center, Tucson, Arizona. After working as an attending physician in Tucson, she followed a recruiting call to the island of Guam, where she served in various roles, including as the director of the emergency department, the EMS Medical Director of Guam, and the Director of the 911 Call System. She has maintained her emergency medicine board certification through three cycles of American Board of Emergency Medicine Board Exams (last in 2014), all three with the help of Med-Challenger.
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